In-hospital 'CODE STEMI' improves door-to-balloon time in patients undergoing primary percutaneous coronary intervention.

Autor: Koh JQ; Department of Cardiology, Peninsula Health, Melbourne, Victoria, Australia.; Department of Medicine, Monash University, Melbourne, Victoria, Australia., Tong DC; Department of Cardiology, Peninsula Health, Melbourne, Victoria, Australia., Sriamareswaran R; Department of Cardiology, Peninsula Health, Melbourne, Victoria, Australia., Yeap A; Department of Cardiology, Peninsula Health, Melbourne, Victoria, Australia., Yip B; Department of Cardiology, Peninsula Health, Melbourne, Victoria, Australia., Wu S; Department of Cardiology, Peninsula Health, Melbourne, Victoria, Australia., Perera P; Department of Cardiology, Peninsula Health, Melbourne, Victoria, Australia., Menon S; Department of Emergency, Peninsula Health, Melbourne, Victoria, Australia., Noaman SA; Department of Emergency, Peninsula Health, Melbourne, Victoria, Australia., Layland J; Department of Cardiology, Peninsula Health, Melbourne, Victoria, Australia.; Department of Medicine, Monash University, Melbourne, Victoria, Australia.
Jazyk: angličtina
Zdroj: Emergency medicine Australasia : EMA [Emerg Med Australas] 2018 Apr; Vol. 30 (2), pp. 222-227. Date of Electronic Publication: 2017 Sep 12.
DOI: 10.1111/1742-6723.12855
Abstrakt: Objective: Reducing time to reperfusion for ST-segment elevation myocardial infarction (STEMI) is essential in improving outcomes. Consequently, numerous strategies have been employed to reduce median door-to-balloon time (DTBT).
Methods: CODE STEMI is an ED physician-activated STEMI notification system. On activation, an announcement is made over the hospital's public announcement (PA) system. We prospectively analysed all in-hours STEMI patients who had primary percutaneous coronary intervention (PPCI) Pre-CODE STEMI (2014) and after CODE STEMI was implemented (2015). The primary end-points were median DTBT and the proportion of STEMI patients achieving a DTBT ≤90 min. The secondary end-points were in-hospital outcomes, and a composite of major adverse cardiac events (MACE) and hospital readmission rates at 30 days and 12 months.
Results: There were 41 and 42 patients in Pre-CODE STEMI and CODE STEMI groups respectively. Baseline characteristics were similar. DTBT was significantly reduced by 22.1 min from 67.1 ± 34.9 min Pre-CODE STEMI to 45.0 ± 22.7 min (P = 0.001) in the CODE STEMI group. Door-to-door time (DTDT) was also reduced from 46.3 ± 30.9 min to 29.4 ± 23.3 min (P = 0.006). A greater proportion of CODE STEMI patients achieved the target DTBT ≤90 min (95.2% vs 73.2%, P = 0.007). CODE STEMI patients had less systolic dysfunction measured by a left ventricle ejection fraction of ≤40% (10.0% vs 27.8%, P = 0.07). There were trends to lower in-hospital mortality rates (4.8% vs 9.8%, P = 0.43), MACE at 30 days and 12 months (4.8% vs 9.8%, P = 0.43; 11.9% vs 22.0%, P = 0.25).
Conclusion: The novel in-hospital in-hours CODE STEMI notification system significantly reduced DTBT in patients undergoing PPCI.
(© 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)
Databáze: MEDLINE
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